Chloroprocaine

DEA Class; Rx

Common Brand Names; Nesacaine, Clorotekal

Short-acting ester-type local anesthetic
Used for infiltration anesthesia; peripheral, sympathetic, epidural, caudal, subarachnoid, intravenous regional (Bier’s method) blocks; and ocular surface anesthesia
Not effective as a topical anesthetic

Indicated for regional anesthesia.

For local anesthesia via infiltration anesthesia or nerve block anesthesia.

Hypersensitivity to para-aminobenzoic acid (PABA) or parabens

Lumbar and caudal epidural anesthesia should be used with extreme caution in persons with the following conditions: Existing neurological disease, spinal deformities, septicemia, and severe hypertension

General and specific contraindications to spinal anesthesia regardless of the local anesthetic use, should be taken into account (eg, decompensated cardiac insufficiency, hypovolemic shock, coagulopathy)

IV regional anesthesia (the anesthetic agent is introduced into the limb and allowed to set in while tourniquets retain the agent within the desired area)

Serious problems with cardiac conduction

Local infection at the site of proposed lumbar puncture

Septicemia

Local anesthetics should only be administered by clinicians who are well versed in diagnosis and management of dose-related toxicity and other acute emergencies which might arise from the block to be employed, and then only after insuring the immediate availability of oxygen, other resuscitative drugs, cardiopulmonary resuscitative equipment, and the personnel resources needed for proper management of toxic reactions and related emergencies

Hypotension and bradycardia are well known side effects of all local anesthetics

Neurological damage may occur after spinal anesthesia, manifesting as paresthesia, loss of sensitivity, motor weakness, paralysis, cauda equina syndrome; occasionally these symptoms persist and can be permanent

Use extreme caution with lumbar and caudal epidural anesthesia in person with existing neurological disease, spinal deformities, septicemia, severe hypertension, heart block, high grade cardiac decompensation, advanced liver or kidney impairment, elderly patients and patients in poor general condition, genetic cholinesterase deficiency, severe anemia, congenital or acquired bleeding disorder, and patients taking anticoagulants

Use preservative free preparations for spinal or epidural anesthesia

DO NOT use solutions with epinephrine in distal areas of body (eg, digit, nose, ear)

Addition of vasoconstrictor, epinephrine, will promote local hemostasis, decrease systemic absorption, and increase duration of action

Monitor patient’s state of consciousness following the injection; anxiety, dizziness, restlessness, tremors, depression, or blurred vision may be signs of CNS toxicity

Chondrolysis associated with intra-articular infusions following arthroscopic and other surgical procedures (off-label use)

Hypersensitivity reactions reported; cross-reactivity among ester-type local anesthetics may occur (see Contraindications)

Respiratory arrest reported with local anesthetics

Data are limited regarding use in pregnant women

Data are not available on the presence of chloroprocaine in human milk, the effects on the breastfed infant, or the effects on milk production

The development and health benefits of breastfeeding should be considered along with the mother’s clinical need for the drug and any potential adverse effects on the breastfed child or from the underlying maternal condition